189979 Using an empirical typology of public health systems to monitor changes in infrastructure and performance

Tuesday, October 28, 2008: 1:10 PM

Glen Mays, PhD, MPH , Dept. of Health Policy & Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
RATIONALE: The availability of essential public health services varies widely across states and communities, as do the mechanisms for organizing and delivering these services. To elucidate these issues, we developed an empirical method of classifying local delivery systems based on the scope of public health activities performed within the community (scope), the proportion of activities contributed by the governmental public health agency (concentration), and the range of other organizations contributing to these activities (integration). In this analysis, we use the empirical typology to assess structural change in public health systems over time. METHODS: A stratified random sample of the nation's 3000 local health department directors (n=497) were surveyed in 1998 (78% response) and again in 2006 (70% response) to determine the availability of 20 common public health activities within their jurisdictions and to identify the types of organizations participating in each activity. Principal components analysis methods were used to classify systems into one of seven structural categories based on the scope, concentration, and integration of activities. Multivariate hierarchical regression models were used to estimate associations between structural change, system performance and population health. RESULTS: Moderate increases in system scope and substantial increases in integration were observed during the 8-year period (p<0.05), while concentration remained relatively stable. Systems experiencing increases in scope and integration were more likely than their counterparts to achieve improvements in perceived performance and reductions in mortality from several preventable causes of death. CONCLUSIONS: Organizational integration, or “border-crossing,” within public health systems may contribute to expanded capacity and improved health.

Learning Objectives:
At the end of this session, participants will be able to: (1) identify and classify local public health delivery systems based on the structural characteristics of scope, concentration, and organizational integration; (2) assess factors that precipitate change in public health system structures; and (3) identify strategies for improving system performance and outcomes through organizational change and integration.

Keywords: Organizational Change, Public Health Administration

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and conducted the study being presented
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.